<%@ page language="java" import="java.util.*" pageEncoding="UTF-8"%>
<%@ include file="/WEB-INF/com/com.jsp"%>

<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
  <head>
    <base href="<%=basePath%>">
     <title>add</title>
     <script src="<%=basePath %>/laydate/laydate.js" ></script>
     <script>
    lay('#version').html('-v'+ laydate.v);
    //常规用法
    laydate.render({
      elem: '#test1' //指定元素
    });
    laydate.render({
      elem: '#test2' //指定元素
    });
    </script>
  </head>
  
  <body>
  
  <div class="panel admin-panel">
<div class="panel-head" id="add"><strong><span class="icon-pencil-square-o"></span>登记慢性病证信息</strong></div>
<div class="body-content">
    <form method="post" class="form-x" action="<%=basePath%>/mxb/MxbCard_Mxbopenregistration.action">  
    <input type="hidden" name="id" value="${mxbCard.id}">
     <input type="hidden" name="persNumber" value="${mxbCard.persNumber }">
       <input type="hidden" name="mxbCardId" value="${mxbCard.mxbCardId }">
      
      <div class="form-group">
          <div class="label">
            <label>登记人姓名：</label>
          </div>
          <div class="field">
          <select name="userId" id="userId" class="input w50">
             <option value="">登记人</option>
				<s:iterator value="sysUserList">
				<option value="${userId}" id="${userId}">${userRealName}</option>
				</s:iterator>
            </select>
            <div class="tips"></div>
          </div>
        </div>
         <div class="form-group">
          <div class="label">
            <label>疾病名称：</label>
          </div>
          <div class="field">
          <select name="mxbId" id="mxbId" class="input w50">
             <option value="">疾病名</option>
				<s:iterator value="mxbPolicicyAllList">
				<option value="${mxbId}" id="${mxbId}">${mxbName}</option>
				</s:iterator>
            </select>
            <div class="tips"></div>
          </div>
        </div>
         <div class="form-group">
        <div class="label">
          <label>起始时间：</label>
        </div>
        <div class="field">
          <input type="text"  id="test1" class="input w50" value="" name="mxbStartDay" />
          <div class="tips"></div>
        </div>
      </div>
     <div class="form-group">
        <div class="label">
          <label>终止时间：</label>
        </div>
        <div class="field">
          <input type="text"  id="test2" class="input w50" value="" name="mxbStopDay" />
          <div class="tips"></div>
        </div>
      </div>
       <div class="form-group">
        <div class="label">
          <label></label>
        </div>
        <div class="field">
          <button class="button bg-main icon-check-square-o" type="submit"> 提交</button>
        </div>
      </div>
    </form>
  </div>
</div> 
</body>
</html>
